Who does this policy apply to?

To workers and crime victims having limited English proficiency or sensory impairment, and receiving benefits from:

The State Fund, or

Self-insured employers, or

The Crime Victims Compensation Program.

Doesn’t apply to

This policy doesn’t apply to interpretive services for workers or crime victims for legal purposes, including but not limited to:

Attorney appointments, or

Legal conferences, or

Testimony at the Board of Industrial Insurance Appeals or any court, or

Depositions at any level.

Note: In these circumstances, payment is the responsibility of the attorney or other requesting party.

Who chooses both the interpretive services provider and when the services are needed

Under the Civil Rights Act of 1964, the healthcare or vocational provider will determine whether effective communication is occurring.

If assistance is needed, the healthcare or vocational provider:

Selects an interpreter to facilitate communication, and

Determines if an interpreter (whether paid or unpaid) accompanying the worker meets the communication needs.

If healthcare or vocational provider determines a different interpreter is needed:

The worker may be consulted in the selection process,

Sensitivity to the worker’s cultural background and gender is encouraged when selecting an interpreter, and

The ultimate decision on who does the interpreting rests with healthcare or vocational provider.

Either paid or unpaid interpreters may assist with communications. In all cases:

A paid interpreter must meet L&I’s credentialing standards (see “Standards and responsibilities for interpretive services provider conduct” listed later in this “Payment policy” section), and

Persons identified as ineligible to provide services in this policy may not be used even if they are unpaid, and

Persons under age 18 may not interpret for workers or crime victims.

Note: Also, see other payment policy sections in this chapter related to eligible and ineligible interpretive services providers, including content under these titles:

Requirements for credentials,

Who must perform these services to qualify for payment,

Who can’t perform these services, and

Who can perform these services but won’t be paid.

Prior authorization

Required

Document translation services require prior authorization and must be requested by the insurer.

Not required

Direct interpretive services (either group or individual) and mileage don’t requireprior authorization on open claims.

Note: Prior to service delivery, providers should check claim status with the insurer.

Who must perform these services to qualify for payment

Note: See unique requirements in other “Payment policy” sections of this chapter for:

IME interpretive and translation services, and

Telephone interpretive services.

Who can’t perform these services

Note: See unique requirements in other “Payment policy” sections of this chapter for:

Document translation services,

Face to face services,

IME interpretive and translation services, and

Telephone interpretive services.

Who can perform these services but won’t be paid

Other persons on occasion may assist the worker or crime victim with language or communication limitations. These persons may include but aren’t limited to:

Family members, or

Friends or acquaintances, or

The healthcare or vocational provider, or

Employee(s) of the healthcare or vocational provider whose primary job isn’t interpretation, or

Employee(s) of the healthcare or vocational provider whose primary job is interpretation but who isn’t a credentialed interpreter or translator, or

Interpreters/translators who don’t comply with all applicable state and/or federal licensing or certification requirements, including but not limited to, business licenses as they apply to the specific provider’s practice or business.

Note: See the definition of family members in “Definitions” at the beginning of this chapter.

Services that are covered

Services that may be payable are:

Except for the initial visit, services prior to claim allowance aren’t payable. If the claim is allowed later, the insurer will determine which services rendered prior to claim allowance are payable, and

Only services to assist in completing the reopening application and for insurer requested IMEs are payable unless or until a decision is made. If a claim is reopened, the insurer will determine which other services are payable.

These services are covered and may be billed to the insurer:

Interpretive services which facilitate language communication between the worker and a healthcare or vocational provider, and

Time spent waiting for an appointment that doesn’t begin at time scheduled (when no other billable services are being delivered during the wait time), and

Assisting the worker to complete forms required by the insurer and/or healthcare or vocational provider, and

A flat fee for an insurer requested IME appointment plus mileage when the worker doesn’t attend, and

Translation of document(s) at the insurer’s request, and

Miles driven from a point of origin to a destination point and return.

Note: Payment is dependent upon service limits and L&I policy.

Interpretive services fee schedule, effective July 1, 2012

Code

Description

L&I limit and authorization information

1 unit of service equals…

Maximum fee

9988M

Group interpretation
Direct services time between more than one client and healthcare or vocational provider, includes wait and form completion time, time divided between all clients participating in group, per minute.

For paid interpreters, healthcare or vocational providers or their staff must verify services on the Interpretive Services Appointment Record (F245-056-000) or a similar interpreter provider’s verification form, which the interpreter will present at the end of the appointment.

Interpretive service appointment and mileage documentation must be submitted to the insurer when services are billed.

Don’t staple documentation to bill forms.

Send documentation separately from bills for State Fund or Crime Victims Compensation Program claims, and:

Additional requirements of hospitals and other facilities

Hospitals, freestanding surgery and emergency centers, nursing homes, and other facilities may have additional requirements for persons providing services within the facility. For example, a facility may require all persons delivering services to have a criminal background check, even if the provider isn’t a contractor or a facility employee.

The facility is responsible for notifying the interpretive services provider of their additional requirements and managing compliance with the facilities’ requirements.

Payment policy: Document translation services

Requirements for credentials

Note: “Requirements for credentials” is identical for “Face to face services” (see next “Payment policy” section of this chapter)

Credentials required for L&I provider account number

An Interpreter or translator must have an active L&I provider account.

To obtain an L&I interpretive services provider account number, an interpreter or translator must submit credentials using the Submission of Provider Credentials for Interpretive Services form (F245-055-000). Also note that:

Credentials accepted include those listed under definitions for certified translator and qualified translator (see “Definitions” at the beginning of this chapter), and

Provisional certification isn’t accepted.

Note: Interpreters and translators can only be paid for services in the languages for which they have provided credentials

Interpreters and translators located outside of Washington State must submit credentials from their:

State Medicaid programs, or

State or national court systems, or

Other nationally recognized programs.

For interpretive services providers in any geographic location, credentials submitted from agencies or organizations other than those listed in the definitions may be accepted if the testing criteria can be verified as meeting the minimum standards listed in the following table.

Note: At the beginning of this chapter, see “Definitions” of certified translator and qualified translator.

Interpreter test(s) consists of, at minimum:

Document translation test(s) consists of, at minimum:

A verbal test of sight translation in both English and other tested language(s); and

A written test in English and in the other language(s) tested; or

A written test in English; and

A written test and work samples demonstrating the ability to accurately translate from one specific source language to another specific target language.

A verbal test of consecutive interpretation in both languages; and

—

For those providing services in a legal setting, a verbal test of simultaneous interpretation in both languages.

—

Maintaining credentials

Interpretive services providers are responsible for maintaining their credentials as required by the credentialing agency or organization.

If the interpretive services provider’s credentials expire or are removed for any reason, the provider must immediately notify the insurer.

Credentialed employees of healthcare and vocational providers

Credentialed employees of healthcare and vocational providers are eligible to receive payment for interpretive services under the following circumstances:

The individual’s sole responsibility is to assist patients or clients with language or sensory limitations, and

The individual is a credentialed interpreter or translator, and

The individual has an L&I provider account number for interpretive services.

Prior authorization

Document translation services are only paid when performed at the insurer’s request.

Services will be authorized before the request packet is sent to the translators.

Who can’t perform these services

Note: “Who can’t perform these services” is identical for “Face to face services” (see next “Payment policy” section of this chapter)

Some persons may not provide interpretation or translation services for workers or crime victims during healthcare or vocational services delivered for their claims. These persons are:

Persons under age 18, and

The legal or lay representative (or any employee of the legal or lay representative)of the:

Worker, or

Crime victim, or

Employer.

Note: Workers or crime victims using children for interpretation purposes must be told that an adult (a person at least 18 years old) must provide these services.

Services that can be billed

Since document translation is an insurer requested service only. Therefore:

Payment for document translation will be made only if the service was requested by the insurer, and

If anyone other than the insurer requests document translation, the insurer must be contacted before services can be approved for payment.

Requirements for billing

Documentation for translation services must include:

Date of service, and

Description of document translated (letter, order and notice, medical records), and

Total number of pages translated, and

Total words translated, and

Target language and source language.

Note: Also see the “Interpretive services fee schedule, effective July 1, 2011” in the “All interpretive services” payment policy section, earlier in this chapter.

Requirements for credentials

An Interpreter or translator must have an active L&I provider account.

To obtain an L&I interpretive services provider account number, an interpreter or translator must submit credentials using the Submission of Provider Credentials for Interpretive Services form (F245-055-000 ). Also note that:

Credentials accepted include those listed under definitions for certified translator and qualified translator (see “Definitions” at the beginning of this chapter), and

Provisional certification isn’t accepted.

Note: Interpreters and translators can only be paid for services in the languages for which they have provided credentials.

Interpreters and translators located outside of Washington State must submit credentials from their:

State Medicaid programs, or

State or national court systems, or

Other nationally recognized programs.

For interpretive services providers in any geographic location, credentials submitted from agencies or organizations other than those listed in the definitions may be accepted if the testing criteria can be verified as meeting the minimum standards listed in the following table.

Note: At the beginning of this chapter, see “Definitions” of certified translator and qualified translator.

Interpreter test(s) consists of, at minimum:

Document translation test(s) consists of, at minimum:

A verbal test of sight translation in both English and other tested language(s); and

A written test in English and in the other language(s) tested; or

A written test in English; and

A written test and work samples demonstrating the ability to accurately translate from one specific source language to another specific target language.

A verbal test of consecutive interpretation in both languages; and

—

For those providing services in a legal setting, a verbal test of simultaneous interpretation in both languages.

—

Maintaining credentials

Interpretive services providers are responsible for maintaining their credentials as required by the credentialing agency or organization.

If the interpretive services provider’s credentials expire or are removed for any reason, the provider must immediately notify the insurer.

Credentialed employees of healthcare and vocational providers

Credentialed employees of healthcare and vocational providers are eligible to receive payment for interpretive services under the following circumstances:

The individual’s sole responsibility is to assist patients or clients with language or sensory limitations, and

The individual is a credentialed interpreter or translator, and

The individual has an L&I provider account number for interpretive services.

Who can’t perform these services

Some persons may not provide interpretation or translation services for workers or crime victims during healthcare or vocational services delivered for their claims. These persons are:

Persons under age 18, and

The legal or lay representative (or any employee of the legal or lay representative)of the:

Worker, or

Crime victim, or

Employer.

Note: Workers or crime victims using children for interpretation purposes must be told that an adult (a person at least 18 years old) must provide these services.

Services that can be billed

Mileage and travel

Interpretive service providers may bill for actual miles driven to perform interpretation services for an individual client or group of clients. (Also see “Requirements for billing,” below.)

Requirements for billing

All face to face interpretive services

Interpretive services providers must use the miscellaneous bill form and billing instructions.

Before payment is made:

All interpreter agency encounter forms or Interpretive Services Appointment Record (ISAR) forms and mileage documentation must be signed by the healthcare or vocational provider or the provider’s staff to verify services including mileage for IME no shows, and

All interpreter agency encounter forms and ISAR forms must be in the claim file.

Note: If a group appointment, include on the form the total number of clients (not healthcare or vocational providers) participating in the appointment.

Actual mileage information including: actual miles from starting location (including street address) to appointment, actual miles (not prorated) from appointment to next appointment or return to starting location (include street address), actual total miles, and

Verification of appointment by healthcare or vocational provider (printed name and signature of person verifying services), and

Date signed.

Individual face to face interpretive services

Services delivered for a single injured worker (client) may include:

Interpretation performed with the worker and a healthcare or vocational provider,

Form completion, and

Wait time (when no other billable services are being delivered).

Note: See definition of wait time in “Definitions” at the beginning of this chapter.

When billing for individual interpretation services:

Only the time actually spent delivering those services may be billed, and

To avoid bill denial, you must bill all services for the same client, for the same date of service, on one bill form, and

Time is counted from when the appointment is scheduled to begin or when the interpreter arrives, whichever is later, to when the services end, and

Time spent travelling between places where interpretive services are performed must be deducted from the total time billed.

Group face to face interpretive services

When interpretive services are delivered for more than one person (regardless of whether all are workers and/or crime victims), the time spent must be prorated between the participants. Send a separate bill, with prorated amounts, for each person.

For example, if three persons are receiving a one hour group physical therapy session at different stations and the interpretive services provider is assisting the physical therapist with all three persons:

The interpretive services provider must bill only 20 minutes per person, and

The time is counted from when the appointment is scheduled to begin or when the interpreter arrives, whichever is later, to when the services end.

Note: Also see the “Interpretive services fee schedule, effective July 1, 2011” in the “All interpretive services” payment policy section, earlier in this chapter.

Payment limits

Daily time limit

The combined total of both individual and group services is limited to 480 minutes (8 hours) per day per interpreter.

Mileage and travel

Mileage is payable for no show appointments for IMEs only.

Before being paid, mileage over 200 miles per day will be reviewed for necessity.

Insurers won’t pay interpretive service providers’ travel time or for travel expenses such as hotel, meals, and parking.

Note: See more details about the payment policy for “IME interpretive and translation services” in the next section of this chapter.

Example of how to bill for individual interpretive services

If you are an interpreter and during one day you…

Then the type of service you will bill for is:

And the relevant data to note is:

And the appropriate units of service and code to bill are:

Drive 8 miles from your place of business to the location of an appointment for a worker.

Mileage

8 miles

8 units of 9986M

Next, the worker has an 8:45 a.m. appointment. You and the worker enter the exam room at 9:00 a.m. The exam takes 20 minutes. The healthcare provider leaves the room for 5 minutes and returns with a prescription and an order for X-rays for the worker. The appointment ends at 9:30 a.m.

Individual interpretive services

8:45 a.m. to
9:30 a.m.
(45 minutes)

45 units of 9989M

Next, you drive 4 miles to the X-ray service provider and meet the worker there.

Mileage

4 miles

4 units of 9986M

Next, you and the worker arrive at the radiology facility at 9:45 a.m. and wait 15 minutes for X-rays, which takes 15 minutes. You both wait 10 minutes to verify X-rays don’t need to be repeated.

Individual interpretive services

9:45 a.m. to
10:25 a.m.
(40 minutes)

40 units of 9989M

Next, you drive 2 miles to the pharmacy and meet the worker.

Mileage

2 miles

2 units of 9986M

Next, you and the worker arrive at the pharmacy at 10:35 a.m. and wait 15 minutes at the pharmacy for prescription. You explain the directions to the worker, which takes 10 minutes.

Individual interpretive services

10:35 a.m. to
11:00 a.m.
(25 minutes)

25 units of 9989M

Finally, after completing the services, you drive 10 miles to your next interpretive services appointment. Since this isn’t your last appointment of the day, when you bill you will split the mileage between the worker and the next client.

Mileage

5 miles

5 units of 9986M

Example of how to bill for group interpretive services

If you are an interpreter and during one day you…

Then the type of service you will bill for is:

And the relevant data to note is:

And the appropriate units of service and code to bill are:

Drive 9 miles from your place of business to the location of an appointment for 3 clients. 2 are insured by the State Fund.

Mileage

9 miles, 3 workers
(9 divided by 3 = 3)

3 units of 9986M to each State Fund claim

Next, the 3 clients begin a physical therapy appointment at 9:00 a.m. You circulate between the 3 clients during the appointment which ends at 10:00 a.m.

Group interpretive services

9:00 a.m. to 10:00 a.m., 3 workers
(60 minutes divided by 3 = 20)

20 units of of 9988M to each State Fund claim

Finally, after completing the appointment, you drive 12 miles to your next appointment location. Since this isn’t your last appointment of the day, when you bill you will split the mileage between the 3 clients and the next client.